REDS study: Retrospective effectiveness study of dalbavancin and other standard of care of the same IV antibiotic class in patients with ABSSSI.

OBJECTIVES: Acute bacterial skin and skin-structure infections (ABSSSIs) are a common source of morbidity in both the community and hospital settings. The current standard of care (SoC) requires multiple-dose intravenous (IV) regimens, which are associated with high hospitalisation rates, concomitant event risks and costs. Dalbavancin is a lipoglycopeptide, long-acting antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin allows treatment of ABSSSIs with a single-shot IV administration or once weekly for 2 weeks, enabling clinicians to treat patients in an outpatient setting or to shorten the length of hospital stay. METHODS: This multicentre, observational, retrospective study compared hospitalised patients who received dalbavancin and patients treated with the three most used IV antibiotics of the same or similar class: vancomycin, teicoplanin and daptomycin. The primary outcome was the time to discharge after starting the study antibiotics. RESULTS: The primary endpoint, time to discharge from the study therapy start, was measured for both groups: the median number of days was 6.5 in the dalbavancin group vs. 11.0 days in the SoC group. Moreover, in subpopulations of patients receiving one or more concomitant antibiotics active for Gram-positives, MRSA and patients with the most prevalent comorbidity (i.e., diabetes), the advantage of dalbavancin in terms of length of stay was confirmed, with a halved time to discharge or more. Safety data on dalbavancin were consistent with data collected in clinical trials. No serious adverse drug reactions related to dalbavancin were reported and most of them were classified as skin and subcutaneous tissue disorders. One serious ADR was reported for daptomycin. CONCLUSIONS: Although the analysis was only descriptive, it can be concluded that dalbavancin may enable a remarkable reduction in length of hospital stay, also confirming the clinical effectiveness and good safety profile demonstrated in clinical trials in a real-world setting.

Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry.

Skin and soft tissue infections (SSTIs) represent a heterogenous group of pathological conditions involving the skin or the underlying subcutaneous tissues, fascia and muscle, characterised by a considerable variety of clinical presentations, severity and possible aetiological pathogens. Although previous analyses on restricted types of SSTIs and population have already been published, we conducted a large nationwide surveillance program on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients and their management. Twenty-nine Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. We included in our database all cases managed by ID specialists participating to the study, independently from their severity or the setting of consultation. Here, we integrated previous preliminary results analysing and reporting data referring to a 3-year period (October 2016-October 2019). During this period, the study population included 478 adult patients with diagnosis of SSTI. The type of infection diagnosed, the aetiological agent involved and some notes on antimicrobial susceptibilities were collected and reported herein. We also analysed the most common co-morbidities, the type and duration of therapy executed, before and after ID intervention and the length of stay. The results of our study provide information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.

A proposal for a comprehensive approach to infections across the surgical pathway.

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.

[The early management of the sepsis: use of a guidelines document in hospital. Experience at "Carlo Poma" Hospital in Mantova]. / La gestione precoce della sepsi: utilizzo di linee-guida ospedaliere. Esperienza dell'Azienda Ospedaliera "Carlo Poma" di Mantova.

Today the sepsis represents a very important clinical entity. The Surviving Sepsis Campaign assessed an incidence of sepsis equal to 3 cases/1,000 inhabitants. In UK more than 30,000 cases of severe sepsis are calculated; furthermore the patients with sepsis are increasing worldwide (near 18 millions of cases per year). Because of its high mortality, the sepsis represents one of the main causes of death in the world, also in the developing countries where it causes near sixty percent of the total deaths yearly. The early diagnosis and therapy are very important elements for the outcome of the patients. The Authors present the results of the adoption in their hospital of a guidelines document for the management of the septic patient, that show a decrease of their mortality due to the early diagnosis and specific treatments.

Toscana virus genome stability: data from a meningoencephalitis case in Mantua, Italy.

In July of 2013, samples from a patient with a neurological syndrome were collected from Mantua hospital and sent to the National Reference Laboratory for Arboviruses (National Institute of Health, Rome). On the basis of the symptoms, serological and molecular assays were performed to diagnose either West Nile virus (WNV) or Toscana virus (TOSV) infection. Molecular and serological tests confirmed TOSV infection. Virus isolation was obtained from cerebrospinal fluid. A full genome sequence was determined from this TOSV strain with next-generation sequencing using Ion Torrent technology. Nucleotide and amino acidic sequences grouped phylogenetically with lineage TOSV A and showed a low genome variability.

[Disseminated nocardiosis in a patient with haemophilia: a problem of differential diagnosis]. / Nocardiosi disseminata in paziente emofilico: un problema di diagnosi differenziale.

Nocardia is found worldwide in soils and dust. In immunocompromised patients the lungs appear to be the most common initial site of infection due to the inhalation of free living organisms. Nocardia asteroides is the most commonly isolated pathogenic Nocardia species. Pulmonary nocardiosis may mimic tuberculosis, staphylococcal or mycotic infections. Disseminated disease mainly occurs in immunocompromised patients with underlying illnesses such as chronic granulomatous disease, human immunodeficiency virus (HIV) infection, in patients undergoing cytotoxic chemotherapy, organ transplantation or prolonged glucocorticoid treatment. Subcutaneous infection occurs from trauma related inoculation of the organism. The Authors describe a clinical case regarding a patient with acquired haemophilia A, admitted to the hospital because of disseminated nocardiosis mimicking a neoplastic disease. He recovered completely after the antibiotic treatment.

Clinical experience with daptomycin in Italy: results from a registry study of the treatment of Gram-positive infections between 2006 and 2009.

The purpose of this study was to evaluate post-marketing efficacy and safety data for therapy with daptomycin (DAP) in Italy. Data from patients treated with DAP at 30 centres between January 2006 and July 2009 were analysed according to the protocol of the EU-CORE(SM). In 359 patients, DAP was most commonly prescribed for skin and skin-structure infections (55%), infective endocarditis (13%), and bacteraemia (12.5%). DAP was associated with rapid improvement, and clinical success rates ranging from 77 to 91%, despite almost half of the patient population being ≥65 years of age, 86% having significant underlying disease, and many being affected by drug-resistant pathogens. Staphylococcus aureus represented 35% of all pathogens isolated. Success rates for all staphylococcal and enterococcal infections were >80%, including methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA). Clinical outcomes were similar for DAP whether used as first- or second-line therapy. DAP was well tolerated even with prolonged treatment.

[Prevention and management of antibiotic-resistant bacterial infections in patients on hemodialysis]. / Prevenzione e gestione delle infezioni da germi antibiotico-resistenti nei pazienti emodializzati.

Infections contracted during hemodialysis are an important aspect of the issue of healthcare-associated infections (HCAIs). The dialyzed kidney patient has a very high risk of infections, which may be life-threatening. Only the strict application of proper nursing standards, in addition to surveillance and good management of the patient, will allow to lower the incidence of infections. We studied the hemodialysis-related infection risk by evaluating the types of patients, medical devices, and nursing practices involved. Patient outcome can be improved by the implementation of correct management practices. The analysis of variables including standards of good practice, hand washing, and surveillance of colonized patients will promote the development of effective measures to reduce the incidence of infections, particularly antibiotic-resistant ones.

[Epidemiology of ESBL-positive Enterobacteriaceae in Mantova hospital (Italy)]. / La problematica della circolazione di Enterobacteriaceae ESBL positive: situazione epidemiologica nell'Azienda Ospedaliera di Mantova.

In a retrospective study concerning the epidemiology of extended-spectrum beta-lactamase (ESBL) positive Enterobacteriaceae during 2007-2008 in the wards of the Carlo Poma hospital in Mantova, Mercurio surveillance software was used to detect alert microorganisms. Our objective was to link the epidemiological data with the type of patient and ward, and to assess the risk factors for such infections in particular nosocomial environments. The study enabled the change in the relative epidemiological data to be detected, and showed that such bacteria can be found almost throughout the hospital.

[Reduced incidence of Staphylococcus isolation in nosocomial setting after introducing preoperative antibiotic prophylaxis guidelines]. / Riduzione dell'incidenza di isolamento di stafilococchi in ambiente nosocomiale dopo I'introduzione di linee-guida di antibioticoprofilassi preoperatoria.

We compare epidemiological data from two twelve-month periods, before and after the introduction of preoperative antibiotic prophylaxis guidelines at Carlo Poma hospital in Mantova, Italy, in June 2003. Considering the results from the microbiology laboratory and the data from the pharmacy, concerning the consumption of some antimicrobials, we noted a significant decrease in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in surgical wards, where the incidence of MRSA had previously exceeded that in medical wards. At the same time, analysis of antibiotic consumption revealed a considerable decrease in third and fourth-generation cephalosporins and an increasing use of cephazolin, in compliance with prophylaxis protocol rules. This trend was confirmed by analysis of the same data regarding the first six months of 2006.

Nosocomial bloodstream infections among human immunodeficiency virus-infected patients: incidence and risk factors.

To assess the incidence of nosocomial bloodstream infections (NBSIs) in human immunodeficiency virus (HIV)-infected patients, and to analyze the main associated risk factors, we performed a 1-year multicenter prospective study of patients with advanced HIV infection who were consecutively admitted to 17 Italian infectious diseases wards. As of May 1999, a total of 65 NBSIs (4.7%) occurred in 1379 admissions, for an incidence of 2.45 NBSIs per 1000 patient-days. Twenty-nine NBSIs were catheter-related bloodstream infections, with a rate of 9.6 central venous catheter-associated infections per 1000 device-days. Multivariate analysis indicated that variables independently associated with NBSIs included active injection drug use, a Karnofsky Performance Status score of <40, presence of a central venous catheter, and length of hospital stay. Mortality rates were 24.6% and 7.2% among patients with and without NBSIs, respectively (P<.00001). In the era of highly active antiretroviral therapy, NBSIs continue to occur frequently and remain severe and life-threatening manifestations.